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It’s like a game of Would You Rather has come to life for a Las Vegas man. The dilemma: would you rather have a 130-pound scrotum or a one-inch penis? Poor Wesley Warren Jr., 49, has experienced both physical abnormalities in the span of just a few years. His genital issues arose in 2008 after he accidentally hit his testicles with his leg while sleeping. After the excruciating pain died down, he awoke the next morning to find that his scrotum was the size of a soccer ball.

His medical condition is called scrotal lymphedema (also known as scrotal elephantiasis), and it occurs when lymph fluid accumulates in the scrotum and the tissue swells, causing the testicle sack to increase dramatically in size. Warren believes his case arose because his sleeping mishap damaged his lymphatic system, triggering the buildup of fluid, but urologist Dr. Joel Gelman doesn’t buy that theory — although he himself struggles to find a medical explanation.

Scrotal lymphedema is rare in the US but somewhat more common in tropical areas of Asia, Africa and Central and South America, where it’s typically caused by a mosquito-spread infection.

Warren’s scrotum grew at a rate of around three pounds per month until it weighed well over 100 pounds, befuddling doctors. Understandably, his condition interfered with every aspect of his life, making it difficult to walk and use the bathroom in a normal manner and leaving him unable to work, drive or even wear pants. In order to cover up his testicles, he would insert his legs into the arms of a hooded sweatshirt and wear it like a pair of pants.

After finally being properly diagnosed, Warren found medical specialists at the University of California Irvine’s Center for Reconstructive Urology who were willing and able to perform surgery on him. But after the 13-hour procedure removed a 132-pound “specimen” (Gelman estimates that while still attached, the growth could have weighed over 160 pounds.), his troubles didn’t end.

He was horrified to find that his penis was a shadow of its former self. “What came out of surgery is a nub an inch long and it doesn’t get any larger,” Warren lamented. Still, he says he’s “grateful” for the surgery and expresses hope that after his recovery process is complete, he can find the one thing he’s missing (other than a 130-pound scrotum): love.